Course contents

Why Breastfeeding is Important

  1. 1 Baby Friendly Initiative

Biochemistry

  1. 1 a. Protein
  2. 2 b. Carbohydrates
  3. 3 c. Milk Lipids (fats)
    1. 3.1 Foremilk vs Hindmilk
    2. 3.2 Breastmilk storage capacity
    3. 3.3 Cholesterol
  4. 4 d. Vitamins
  5. 5 e. Minerals
    1. 5.1 Calcium
    2. 5.2 Iron
    3. 5.3 Iodine
  6. 6 f. Water
  7. 7 The taste of breastmilk
    1. 7.1 Dietary advice
  8. 8 What should I remember?
  9. 9 Self-test Quiz

Immunology

  1. 1 Protective components of breastmilk
    1. 1.1 Proteins
      1. 1.1.1 Immunoglobulins
      2. 1.1.2 Lactoferrin
      3. 1.1.3 Alpha-Lactalbumin
      4. 1.1.4 Lysozyme
    2. 1.2 Carbohydrates
      1. 1.2.1 Oligosaccharides
    3. 1.3 Lipids and milk fat globules
    4. 1.4 Cellular components
    5. 1.5 Other protective factors
  2. 2 What should I remember?
  3. 3 Self-test Quiz

Relative risks

  1. 1 Acute diseases attributable to artificial feeding
    1. 1.1 Diarrhoea (diarrhea)
    2. 1.2 Otitis media (middle ear infection)
    3. 1.3 Pneumonia
    4. 1.4 Urinary Tract Infection
    5. 1.5 Necrotising Enterocolitis
    6. 1.6 Septicemia and Meningitis
  2. 2 Chronic diseases attributable to artificial feeding
    1. 2.1 Type 1 Diabetes Mellitus (Insulin-dependent diabetes)
      1. 2.1.1 Type 2 Diabetes
    2. 2.2 Coeliac (Celiac) Disease
    3. 2.3 Obesity
    4. 2.4 Childhood Cancer
    5. 2.5 Inflammatory Bowel Diseases
    6. 2.6 Allergic Responses
  3. 3 Developmental Deficits
    1. 3.1 Intelligence
  4. 4 Sudden Infant Death Syndrome (SIDS)
  5. 5 What should I remember?
  6. 6 Self-test Quiz
  7. 7 Assessment Quiz

Communication Skills

  1. 1 Personal Qualities
    1. 1.1 Genuineness
    2. 1.2 Non-possessive love
    3. 1.3 Empathy
  2. 2 What should I remember?
  3. 3 Self-test quiz

Non-verbal

  1. 1 What do you want to communicate?
    1. 1.1 Posture
    2. 1.2 Appropriate body motion
    3. 1.3 Eye contact
    4. 1.4 Minimal encouragers
    5. 1.5 Non-distracting environment
    6. 1.6 Time
  2. 2 What should I remember?
  3. 3 Self-test Quiz

Listening skills

  1. 1 Reflective listening
    1. 1.1 Paraphrasing
    2. 1.2 Reflecting feelings
  2. 2 Appropriate questioning
    1. 2.1 About questioning
  3. 3 What should I remember?

Building confidence

  1. 1 Acceptance
  2. 2 Avoiding judgmental words
  3. 3 Acknowledge what is right
  4. 4 Use language that is easily understood
  5. 5 Provide relevant information
  6. 6 What should I remember?

An example

  1. 1 An example of good communication skills
  2. 2 Assessment Quiz

Pregnancy Care

  1. 1 Baby Friendly Step 3 and Point 3
  2. 2 Broaching the topic
  3. 3 When the mother does not breastfeed
    1. 3.1 Prenatal education
  4. 4 What should I remember?

The feeding decision

  1. 1 What is most influential?
  2. 2 But not everyone can breastfeed!
  3. 3 What should I remember?
  4. 4 Self -test quiz

The barriers

  1. 1 Societal barriers
  2. 2 Health provider knowledge, skills and management
    1. 2.1 Baby Friendly Step 2 and Point 2
  3. 3 Postnatal perceptions
    1. 3.1 Breastfeeding and separations
  4. 4 Breastfeeding in special circumstances
  5. 5 What should I remember?

Physical preparation

  1. 1 Nipple preparation
  2. 2 Prenatal breast examination
    1. 2.1 Inspection
    2. 2.2 Palpation
  3. 3 Record-keeping
  4. 4 What should I remember?
  5. 5 Self-test Quiz
    1. 5.1 Assessment Quiz

The Birth Experience

  1. 1 Lactation physiology
    1. 1.1 Lactogenesis II
    2. 1.2 What could delay or inhibit lactogenesis II?
      1. 1.2.1 Stress and breastfeeding
  2. 2 What should I remember?
  3. 3 Self-test quiz

The first hours

  1. 1 Baby Friendly Step 4
  2. 2 Immediately following birth
  3. 3 The first breastfeed
  4. 4 The role of the birth attendants
  5. 5 Addressing barriers to skin-to-skin
  6. 6 Maternal-infant bonding
  7. 7 What should I remember?
  8. 8 Self-test quiz

Labor interventions

  1. 1 Analgesia during labor
  2. 2 Neuraxial pain relief (epidural/spinal)
  3. 3 Cesarean (caesarean) section or vaginal instrumental birth
  4. 4 Assisting a mother following an assisted delivery
  5. 5 What should I remember?
  6. 6 Self-test quiz

Postnatal interventions

  1. 1 Separation of mother and newborn
    1. 1.1 Effect on newborn
    2. 1.2 Effect on oxytocin
    3. 1.3 Effect on breastfeeding
  2. 2 Washing mother or newborn
  3. 3 Suctioning of the newborn
  4. 4 What should I remember?
  5. 5 Self-test quiz
  6. 6 Assessment Quiz

Breastfeeding the Baby

  1. 1 It's a team effort!
    1. 1.1 Preparing to guide the mother
  2. 2 What should I remember?

Positioning Principles

  1. 1 Mother's position
  2. 2 Baby's position
    1. 2.1 Principles of positioning
    2. 2.2 Biological nurturing feeding position
    3. 2.3 The principles are exactly the same for ALL positions
  3. 3 The well-latched baby
  4. 4 What should I remember?
  5. 5 Self-test Quiz

Breastmilk transfer

  1. 1 Understanding the anatomy
  2. 2 Positive pressure transfer
  3. 3 Negative pressure transfer
  4. 4 What should I remember?
  5. 5 Self-test Quiz

Assessing breastfeeding

  1. 1 The five-step process
    1. 1.1 1. Gather information and plan for the visit
    2. 1.2 2. Feeding observation
      1. 1.2.1 What is involved in a 'naturalistic observation'?
    3. 1.3 3. Exploration of strategies for improvement
    4. 1.4 4. Develop an action plan
    5. 1.5 5. Communication of results
  2. 2 What should I remember?
  3. 3 Assessment Quiz

A time to learn

  1. 1 How to provide education effectively
  2. 2 Postnatal education
  3. 3 What should I remember?
  4. 4 Self-test quiz

Practical skills

  1. 1 Baby Friendly Step 5 and Point 4
  2. 2 Expressing breastmilk
    1. 2.1 Hand expressing
    2. 2.2 Pumping breastmilk
    3. 2.3 Storing breastmilk for a healthy baby
    4. 2.4 Using the expressed breastmilk
  3. 3 Supporting mothers who are separated from their infants
    1. 3.1 Employment and breastfeeding
  4. 4 What should I remember?
  5. 5 Self-test quiz

Breastfeeding messages

  1. 1 Baby Friendly Step 8
  2. 2 How often should my baby breastfeed?
  3. 3 Is my baby getting enough breastmilk?
    1. 3.1 Twins, or more!
      1. 3.1.1 Can mothers produce enough milk for multiples?
      2. 3.1.2 Assisting breastfeeding
  4. 4 When should I begin giving baby other foods?
    1. 4.1 Baby Friendly Point 5
  5. 5 When should I wean my baby from the breast?
  6. 6 What should I remember?
  7. 7 Self-test quiz

Normal growth

  1. 1 Weighing of babies is not an innocuous procedure
  2. 2 What influences movement through growth curves?
  3. 3 Accurately weighing an infant
  4. 4 What should I remember?
  5. 5 Self-test Quiz

Sleep

  1. 1 Rooming-in in Hospital
    1. 1.1 Baby Friendly Step 7
  2. 2 How long should my baby sleep?
  3. 3 Where should my baby sleep?
  4. 4 What should I remember?
  5. 5 Self-test Quiz

Psychological support

  1. 1 Maternal self-confidence and self-efficacy
  2. 2 Influencing self-confidence and self-efficacy
  3. 3 What should I remember?
  4. 4 Self-test Quiz

Discharge planning

  1. 1 Preventing common problems
    1. 1.1 Timing of follow-up
    2. 1.2 Critical warning signs
    3. 1.3 Contraception
  2. 2 Consolidating learning
    1. 2.1 Referral to mother-to-mother support network
      1. 2.1.1 Baby Friendly Step 10 and Point 7
  3. 3 What should I remember?
  4. 4 Self-test Quiz
  5. 5 Assessment Quiz

Infant Challenges

  1. 1 Infant Challenges

Late preterm infant; Non-latching

  1. 1 The 'late preterm' baby
    1. 1.1 Postpartum care
    2. 1.2 Lactation Management
    3. 1.3 What should I remember?
    4. 1.4 Self-test quiz
  2. 2 The Non-latching Baby
    1. 2.1 Your first responsibility
    2. 2.2 Principles of management
      1. 2.2.1 The Action Plan
    3. 2.3 Breast refusal in the older baby
    4. 2.4 What should I remember?
    5. 2.5 Self-test quiz

Hypoglycemia; Jaundice

  1. 1 Pathologic Neonatal Hypoglycemia
    1. 1.1 Physiology
    2. 1.2 Diagnosing pathologic neonatal hypoglycemia
      1. 1.2.1 Clinical signs to observe for:
      2. 1.2.2 Which infants are at risk?
    3. 1.3 Preventing pathologic hypoglycemia
      1. 1.3.1 What about early feeding?
    4. 1.4 Clinical management of pathologic hypoglycaemia
    5. 1.5 What should I remember?
    6. 1.6 Self-test quiz
  2. 2 Jaundice
    1. 2.1 Normal serum bilirubin levels
    2. 2.2 Causes of abnormal bilirubin levels
    3. 2.3 Physical appearance
    4. 2.4 Management of hyperbilirubinemia
    5. 2.5 What should I remember?
    6. 2.6 Self-test quiz

Supplementation

  1. 1 Exclusive breastfeeding
    1. 1.1 Baby Friendly Point 5 and Step 6
  2. 2 Pre-lacteal feeds
    1. 2.1 Effect on mother and infant
  3. 3 Supplementation
    1. 3.1 Medical indications for supplementation
      1. 3.1.1 Supplements in order of preference
    2. 3.2 Effect on infant health
    3. 3.3 Effect on breastfeeding
    4. 3.4 Effect on the mother
    5. 3.5 Effect on infant serum glucose levels
    6. 3.6 Effect on hyperbilirubinemia
    7. 3.7 Effect on atopic disease
    8. 3.8 Effect on infant digestion and absorption
    9. 3.9 Human Immunodeficiency Virus (HIV)
    10. 3.10 Legal implications
    11. 3.11 What should I remember?
    12. 3.12 Self-test quiz

Crying baby

  1. 1 My baby cries a lot. What should I do?
  2. 2 Pacifiers/Dummies
    1. 2.1 Baby Friendly Step 9 and Point 4
    2. 2.2 Sucking and breastfeeding
  3. 3 When crying is excessive
    1. 3.1 Lactose malabsorption/overload
      1. 3.1.1 Presentation
      2. 3.1.2 Management
    2. 3.2 Colic
      1. 3.2.1 Management
    3. 3.3 Gastroesophageal Reflux
      1. 3.3.1 Gastroesophageal Reflux Disease
      2. 3.3.2 Breastfeeding Management
  4. 4 What should I remember?
  5. 5 Self test quiz

Inadequate weight gain

  1. 1 Definition of failure to thrive (FTT)
  2. 2 Cause of failure to thrive
  3. 3 What to do when you suspect FTT
    1. 3.1 Record a thorough history
    2. 3.2 Examination of the baby
      1. 3.2.1 Test weighing
      2. 3.2.2 What do you see?
  4. 4 Management
    1. 4.1 Parent education and counseling
    2. 4.2 Step 1
    3. 4.3 Step 2
      1. 4.3.1 What supplement shall I use?
      2. 4.3.2 How will the supplement be given to the infant?
      3. 4.3.3 When to supplement
    4. 4.4 Step 3
    5. 4.5 Step 4
  5. 5 What should I remember?
  6. 6 Self-test quiz
  7. 7 Assessment Quiz

Feeding-line device at the breast

  1. 1 When to choose an at-breast feed line
  2. 2 Equipment
  3. 3 Preparation
  4. 4 Technique

Cup feeding

  1. 1 When to choose cup feeding
  2. 2 Equipment
  3. 3 Preparation
  4. 4 Technique

Finger Feeding

  1. 1 When to consider finger feeding
  2. 2 Preparation
  3. 3 Equipment
  4. 4 Finger feeding technique
    1. 4.1 Teach finger feeding

Bottle feeding

  1. 1 When to use bottle feeding
  2. 2 Considerations when bottlefeeding a breastfed infant
  3. 3 Bottle feeding technique
    1. 3.1 Assess a bottle feed
  4. 4 Good bottle feeding practices are essential
    1. 4.1 Preventable dangers

Maternal Challenges

  1. 1 Maternal Challenges

Engorgement

  1. 1 Breast fullness
    1. 1.1 Signs and Symptoms
  2. 2 Engorgement
  3. 3 Clinical Management
  4. 4 Areolar oedema/edema
  5. 5 What should I remember?
  6. 6 Self-test quiz

Nipple Pain

  1. 1 Technique factors
  2. 2 Maternal anatomy issues
    1. 2.1 Inverted or non-protractile nipples
  3. 3 Infant anatomy issues
    1. 3.1 Ankyloglossia (tongue tie)
      1. 3.1.1 Presentation
      2. 3.1.2 Treatment
  4. 4 Nipple infections
    1. 4.1 Fungal overgrowth (candidiasis, thrush, yeast)
      1. 4.1.1 Presentation
      2. 4.1.2 Management
    2. 4.2 Bacterial infection
  5. 5 Treatment of nipple damage
  6. 6 What should I remember?
  7. 7 Self-test quiz

Breast Problems

  1. 1 Blocked (Plugged) Duct
  2. 2 Mastitis
    1. 2.1 Aetiology
    2. 2.2 Preventing Mastitis
    3. 2.3 Diagnosis
    4. 2.4 Management
    5. 2.5 Complications
  3. 3 What should I remember?
  4. 4 Self-test quiz

Insufficient breastmilk

  1. 1 Perceived breastmilk insufficiency
  2. 2 How is breastmilk production regulated?
    1. 2.1 Lactogenesis III
      1. 2.1.1 Breast storage capacity and rate of breastmilk production
  3. 3 Insufficient breastmilk
    1. 3.1 Diagnosis
      1. 3.1.1 Delayed onset
    2. 3.2 Management
  4. 4 What should I remember?
  5. 5 Self-test quiz

Medical, Surgical Issues

  1. 1 Diabetes mellitus
    1. 1.1 Impact on lactation
  2. 2 Maternal overweight and obesity
  3. 3 Thyroid disease
  4. 4 Hepatitis
  5. 5 HIV
    1. 5.1 WHO Recommendations for infant feeding
  6. 6 Breast surgery
  7. 7 Breastfeeding and medication usage
  8. 8 What should I remember?
  9. 9 Self-test quiz
  10. 10 Assessment Quiz

Promotion, Protection and Support

  1. 1 Promotion, Protection and Support

The International Code of Marketing of Breastmilk Substitutes

  1. 1 Aim of the WHO Code
    1. 1.1 The safe and adequate nutrition of all infants.
  2. 2 What's covered by the WHO Code?
    1. 2.1 Breastmilk substitute
  3. 3 Promotion and product information
  4. 4 Free samples
  5. 5 What can you do?
  6. 6 What should I remember?
  7. 7 Self-test quiz

The Baby Friendly Initiative

  1. 1 Innocenti Declaration
  2. 2 The Baby Friendly Initiative
    1. 2.1 Baby Friendly hospitals
    2. 2.2 Baby Friendly communities
    3. 2.3 Does Baby Friendly Work?
    4. 2.4 Becoming accredited
  3. 3 What should I remember?
  4. 4 Self-test quiz

Young Child Feeding

  1. 1 What should I remember?

Local initiatives

  1. 1 Breastfeeding in public
    1. 1.1 Baby Friendly Point 6
  2. 2 Supporting mothers in the community
    1. 2.1 Baby Friendly Step 10 and Point 7
  3. 3 Engaging the Community
  4. 4 What should I remember?
  5. 5 Self-test quiz
  6. 6 Assessment Quiz

Infant feeding in emergencies

  1. 1 The problem
  2. 2 The solution for the breastfed infant
    1. 2.1 Some frequently asked questions
  3. 3 The solution for the artificially fed infant
  4. 4 What can you do to help?

Closing session

  1. 1 Closing session